Methotrexate

These instructions are for Children's Hospital of Philadelphia (CHOP) patients with certain types of cancer who are prescribed methotrexate.

Important information:

• Methotrexate is a chemotherapy that may be given by mouth or by intravenous or intrathecal injection.

• It injures the cancer cells and causes them to die.

• The oral form (taken by mouth) comes in tablets and liquid formulations. The liquid formulation is known by the brand name Xatmep®. Based on insurance, Xatmep® may come from a specialty pharmacy. Your oncology team will discuss pharmacy options with you.

• Methotrexate is usually given once a week during certain phases of chemotherapy treatment. The oral dose is not to be given during a week a spinal tap is scheduled.

• Side effects may include:

  • Nausea or vomiting

  • Irritation to the liver

  • Decreased blood counts and increased risk of infection

Instructions for methotrexate:

• If your child is prescribed a tablet, it should be swallowed whole, unless instructed otherwise. Your oncology team will tell you if you should follow different instructions.

• If your child is prescribed liquid, measure the dose carefully with an oral syringe provided by the pharmacy. Ask your nurse or pharmacist how to measure your child's dose.

• The liquid formulation, Xatmep®, must be stored in the refrigerator. If accidentally left at room temperature, remaining medicine must be discarded after 60 days of being at room temperature.

• It is recommended to wear gloves when touching this medicine and wash your hands after removing gloves. If gloves are unable to be worn, please wash your hands with soap and water thoroughly after handling the medicine.

• It is recommended to wear gloves when touching soiled diapers and urine while your child is taking this medicine. Wash your hands after removing gloves. If gloves are unable to be worn, please wash your hands with soap and water very well after handling the medicine.

• Talk to your healthcare provider about checking your child's blood work regularly.

Call your CHOP oncology team with any questions or concern, or if your child:

• Misses any doses

• Cannot swallow the tablet whole or vomits immediately after taking the medicine

• Has severe nausea, vomiting or diarrhea

• Has unusual bruising or bleeding

• Has severe mouth pain

• Has yellow coloring of the skin or eyes

• Has a rash

• Has a fever of 101.3°F (38.5°C) once, or 100.4°F (38°C ) three times in a 24-hour period, taken at least 2 hours apart

If your child shows signs of a life-threatening reaction, call 911.

Oncology Contact Information

Reviewed on March 1, 2022, by Sara McDonough, CRNP-AC; Katie Oranges, MSN, CRNP, CPHON; Erika Pineda, PharmD, BCPPS